Written by Renata Filiac, MSHW

Introduction

            Inflammatory bowel disease (IBD) is categorized into two separate chronic illnesses, Ulcerative Colitis (UC) and Crohn disease (CD). Each IBD has different etiologies, but affect the digestive process; however, similarities exist for each including genetic mutations, environmental, and immunological risk factors as well as the potential to develop colon cancer (Banasik & Copstead, 2019). Consuming the Western diet highly increases the chance of developing an IBD, which is associated with the overconsumption of refined carbohydrates, protein, overly processed foods, sugar, and saturated fat; this is a modifiable factor in maintaining remission of IBD (Fábián, Rutka, Ferenci, Bor, Bálint, Farkas, Milassin, Szántó, Lénárt, Nagy, Szepes, & Molnár, 2018; Banasik & Copstead, 2019).

UC, affecting 2 and 14 per 100,000 persons in North America, is an inflammatory disease that develops in the mucosa of the rectum and colon, with changes most severe in the rectum. Although most people with UC have recurrent attacks, there are chances that a person will only have one exacerbation. An exacerbation is due to damage of the crypt epithelium, which leads to an excessive amount of leukocytes as a response and the formation of abscesses in the crypts, thus causing inflammation and ulceration as well as other symptoms, such as abdominal pain, diarrhea, and rectal bleeding (Banasik & Copstead, 2019).

CD appears to be a consequence of a blocked lymphatic system in the gastrointestinal tract (GI), which results in inflammation in the intestinal walls and affecting the proximal portion of the colon. CD is apparent in 3 and 15 per 100,000 persons, with symptoms that involve abdominal pain, fistulas, perianal fissures, abscesses, the development of granulomas, and bloody stools. An exacerbation can lead to pathological changes in the bowel, which makes intestinal content incapable of absorbing (Banasik & Copstead, 2019).

Conventional medicine and treatment are primarily used for IBD which include a range of antibiotics, steroids, immunomodulating agents and antitumor necrosis factor therapy; however, these options can present severe side effects as well as significant cost issues. Although there is no cure, complementary and alternative medicine can be a beneficial therapy for people with IBD because there are limited to no side effects, they are cost-efficient, and can create lasting remission (Fábián, Rutka, Ferenci, Bor, Bálint, Farkas, Milassin, Szántó, Lénárt, Nagy, Szepes, & Molnár, 2018; Banasik & Copstead, 2019; Limdi, 2018; Lin & Cheifetz, 2018).

Results/Discussion

Considering complications and adverse effects from medication develop during remission, it is best to gain control of IBD with unique and alternative treatment. In a study presented by Fábián, Rutka, Ferenci, Bor, Bálint, Farkas, Milassin, Szántó, Lénárt, Nagy, Szepes, and Molnár (2018), the authors established that people suffering from IBD related diseases, such as UC and CD, have a frequency to use herbs and botanicals, make lifestyle modifications, and use mind and body therapies, as these tend to treat the whole of the patient. The most critical factor for patients with IBD is lifestyle modifications, which include the consumption of a special diet, cessation of smoking, and exercise, with the implication these modifications limit inflammation and influence proper digestion (Fábián, Rutka, Ferenci, Bor, Bálint, Farkas, Milassin, Szántó, Lénárt, Nagy, Szepes, & Molnár, 2018).

The researcher, Limdi (2018), suggests specific diets that could be beneficial with people with IBD. These diets have similarities as they exclude dairy products, processed foods, complex grains, refined sugars, and processed and domesticated meats. Diets high in polyunsaturated and monounsaturated omega-3 fatty acids play a role in regulating inflammation, such as incorporating the components from oily fish, like salmon and mackerel, and α-linolenic acid from plants. Diets high in polyunsaturated omega-6 fatty acids should be limited due to their pro-inflammatory response, exacerbation, and increased risk of IBD; this includes decreasing the consumption of red and processed meat, alcohol, margarine, and cooking oils (sunflower and corn oil) (Limdi, 2018). Dietary fiber, non-digestible carbohydrates (prebiotics), and probiotics are essential for protection as they play a role in promoting epithelial integrity through an antioxidant effect and bacterial diversity within gut microbial; eating a diet high in vegetables, fruits, fermented foods, and unrefined grains can reduce flare-ups from IBD (Limdi, 2018).

Herbs, botanicals, and supplements are beneficial for reducing symptoms and the use of conventional medications (Fábián, Rutka, Ferenci, Bor, Bálint, Farkas, Milassin, Szántó, Lénárt, Nagy, Szepes, & Molnár, 2018; Lin & Cheifetz, 2018). Herbs and botanicals that have been used by people with IBD because of their anti-inflammatory and anti-oxidative properties on gut epithelial cell lines; these include aloe vera, milk thistle, walnut leaf, curcumin, wheatgrass, Plantago ovata, medicinal fungi, and chamomile (Fábián, Rutka, Ferenci, Bor, Bálint, Farkas, Milassin, Szántó, Lénárt, Nagy, Szepes, & Molnár, 2018; Lin & Cheifetz, 2018). Medical marijuana, such as cannabinol and θ-9-tetrahydrocannabinol, is also being considered as an essential treatment due to its actions via the endocannabinoid system activating the CB1 and CB2 receptors involved in a variety of physiological processes. Medical marijuana has been shown to relieve symptoms, improve quality of life and ability to work as well as reduce the use of conventional treatment (Lin & Cheifetz, 2018).

Mind and body therapies have also been used by patients with IBD. Techniques, such as relaxation practices, stress management, kinesiology, yoga, massage therapy, and acupuncture have been evaluated and reported as advantageous in helping relieve symptoms and influence remission as well as reduce the use of conventional treatment as seen in a study Fábián, Rutka, Ferenci, Bor, Bálint, Farkas, Milassin, Szántó, Lénárt, Nagy, Szepes, & Molnár, 2018).

Conclusions

            Inflammatory bowel disease is categorized into two separate chronic illnesses, Ulcerative Colitis and Crohn disease. Both disorders present themselves as digestive system disorders with similar risk factors and the potential to progress into colon cancer if not maintained and in remission. Many patients with IBD have used a conventional treatment which has the likelihood to generate adverse effects as well as are not cost efficient. Complementary and alternative medicinal therapy, such as lifestyle modification, exercise, cessation of smoking and other inflammatory causing agents, and the addition of herbs, botanicals, supplements, and relaxation modalities, have been explored as necessary options for treating patients with IBD.

References

Banasik, J. L. & Copstead, L-E. C. (2019). Pathophysiology (6th ed.). St. Louis, MO: Elsevier

Inc.

Fábián, A., Rutka, M., Ferenci, T., Bor, R., Bálint, A., Farkas, K., Milassin, Á., Szántó, K.,

Lénárt, Z., Nagy, F., Szepes, Z., & Molnár, T. (2018). The Use of Complementary and

Alternative Medicine Is Less Frequent in Patients with Inflammatory Bowel Disease

Than in Patients with Other Chronic Gastrointestinal Disorders. Gastroenterology

research and practice, 2018, 9137805. doi:10.1155/2018/9137805

Limdi J. K. (2018). Dietary practices and inflammatory bowel disease. Indian journal of

gastroenterology : official journal of the Indian Society of Gastroenterology, 37(4), 284-

292. doi: 10.1007/s12664-018-0890-5

Lin, S. C., & Cheifetz, A. S. (2018). The Use of Complementary and Alternative Medicine in

Patients With Inflammatory Bowel Disease. Gastroenterology & hepatology, 14(7), 415-

425. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6111500/